Socioeconomic and demographic patterns associated with treatment delay in prostate cancer: An analysis of the National Cancer Database.
Authors: Faith Abodunrin, Oluwatayo Adeoye, Nick Nelson, Nwonuwkuru I Amadi, Peter T. Silberstein, Connor Tupper
Journal: Journal of Clinical Oncology (2023)

e17122 Background: Prostate cancer is the second leading cause of cancer related deaths in men. In 2023, about 288,300 new cases of prostate cancer are expected . Delays in cancer treatment can impact patients’ outcomes. In our study, we sought to describe socioeconomic and demographic factors influencing time to treatment in prostate cancer. We also studied the trend in time to treatment through the years. Methods: Using the National Cancer Database, we identified 1,605,396 patients diagnosed with prostate cancer between 2004 and 2019. Variables used for assessment include age at diagnosis, race, Charlson-Deyo score, stage at diagnosis, insurance status, median household income in patient’s zip code and year of treatment. We separated patients into two groups: those who started treatment &lt; 60 days and patients who started treatment &gt; 60 days using statistical analyses. We used Chi-square test to assess for differences within these groups and multivariable analysis to determine relationships between time to treatment and the socioeconomic and demographic variables. All tests were performed with a significance level of a = 0.05. Results: Out of 1,605,396 patients included in this study, 806,576 patients began treatment 60 days or less after diagnosis and 798,820 began treatment over 60 days after diagnosis. Older patients (age &gt; 71) were less likely to be treated later than younger patients aged &lt; 60 years (OR 0.530). Black and Hispanic patients were significantly more likely to start treatment later than white patients (OR 1.231; OR 1.086 p &lt; 0.001). Compared to uninsured patients, those with private and other government coverage were more significantly likely to begin treatment later (OR 1.144; OR 1.469 p &lt; 0.001). Patients with advanced stage prostate cancer were at lower risk for delayed treatment compared to those with localized disease (OR 0.218 P &lt; 0.001). Compared to community programs, patients at academic/research programs were significantly more likely to begin treatment later (OR 2.097 p &lt; 0.0001). In 2004, 40.5% patients began treatment over 60 days from diagnosis compared to 55.1% in 2019 (p &lt; 0.001). We found that patients diagnosed between 2016 and 2019 were more likely to be treated later than those diagnosed between 2004-2007 (OR 1.717 p &lt; 0.001). Conclusions: Increased rate of later time to treatment were seen in younger patients, minority groups, staging at diagnosis less than stage IV, patients treated at academic or research programs, and patients diagnosed between 2016-2019. This is likely due to the rise of active surveillance rather than immediate treatment as a management strategy in prostate cancer. Black men are at increased risk for advanced disease, hence, treatment delays should be avoided in these patients. Institution-level studies should be done to determine the pattern of treatment and address treatment delays.